Single Umbilical Artery Resmy Palliyil Gopi. Umbilical cord 2 umbilical arteries 1 umbilical vein...
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Transcript of Single Umbilical Artery Resmy Palliyil Gopi. Umbilical cord 2 umbilical arteries 1 umbilical vein...
Single Umbilical Artery
Resmy Palliyil Gopi
Umbilical cord
2 umbilical arteries 1 umbilical vein Rudimentary allantois Remnant of omphalomesenteric duct Whartons jelly
Incidence
Most common congenital malformation of the umbilical cord
5-10 in 1000 births (35-70 in 1000 twin births)
Left artery tends to be absent more often than the right
More common in Caucasian women
Conditions associated with single umbilical artery
Advanced maternal age Multiparity Maternal diabetes Hypertension / toxemia Ante partum hemorrhage Poly/oligo hydramnios
Pathogenesis
Primary agenesis Secondary atrophy or atresia of a previously
normal umbilical artery Persistence of the original allantoic artery of
the body stalk
Classification of SUA
Type
# of patent vessels
Consists of Frequency
I two One UA (allantoic) and left UV
Common
II two One UA (vitelline) and left UV
Rare
III three One UA and both UV Very rare
IV two One UA and right UV Very rare
Associated prenatal complications
Isolated (1/2 to 2/3rd) Associated congenital malformations (30%)
– Fetal structural abnormalities– Chromosomal abnormalities (trisomy 18/13)– Genetic syndromes (VATER, sirenomelia sequence) – IUGR– Prematurity– Still birth and spontaneous abortions– Placental abnormalities
Diagnosis
prenatal– Ultrasound (only two vessels are seen and artery is
abnormally large)– Color Doppler
postnatal– Examination of the cord
Color Doppler
Management considerations
Detailed ultrasonographic examination Fetal echocardiography Fetal genetic testing Enhanced fetal surveillance
– Serial ultrasound to assess fetal growth– Biophysical profile, NST
Physical evaluation of the neonate Neonatal renal ultrasonography
Prognosis
- depends on the associated anomalies Recurrence risk
- Unknown
Abnormalities of the umbilical cord
Abnormalities of the cord length and diameter
– Short cords and long cords
Abnormalities of the umbilical cord
Distortional abnormalities– loops, knots (true or false), torsions
and twists
True knot
False knot
Twist
Other abnormalities of the umbilical cord
Neoplasms of the umbilical cord
– Thrombosis, hemangioma, hematoma, teratoma
edema
Velamentous insertion of the umbilical cord
Thank you